Impact of radiological imaging and clinical scoring systems on the clinical course of critically ill geriatric patients with COVID-19 presenting to the emergency department

ABSTRACT Impact of Radiological Imaging and Clinical Scoring Systems on the Clinical Course of Critically Ill Geriatric Patients with COVID-19 Presenting to the Emergency Department Introduction: In our study investigating the effects of radiological imaging (CO RADS) and clinical scoring systems (APACHE-II, MuLBSTA, SII) on the clinical course and mortality of critically ill geriatric COVID-19 patients (aged ≥65 years) admitted to the emergency department and subsequently transferred to the intensive care unit, we aimed to evaluate the prognostic value of these parameters when used in combination and their contribution to clinical decision-making processes in patient management. Materials and Methods: This retrospective observational study included 221 patients aged 65 years and older who were admitted to the Emergency Department (ED) of Çukurova University Faculty of Medicine and subsequently transferred to the COVID-19 intensive care unit between March 11, 2020, and February 1, 2023. Demographic data, vital signs, laboratory results, CO-RADS stages, APACHE-II, MuLBSTA, and SII scores, as well as intensive care outcomes, were retrieved from the hospital's automation system and physical patient files. The data were divided into two groups-deceased and surviving patients-and compared accordingly. Results: Of the patients included in the study, 122 (55.2%) were male, and 99 (44.8%) were female, with a mean age of 77 ± 7.98 years. The mortality rate was determined to be 49.8%. In deceased patients, APACHE-II and MuLBSTA scores were significantly higher, and CO-RADS stage 6 was more frequently observed. SII values were also significantly elevated in the deceased group. Notably, deceased patients exhibited significantly lower systolic/diastolic blood pressure, mean arterial pressure, oxygen saturation, and Glasgow Coma Scale scores, while the shock index was higher. Laboratory findings revealed significantly higher levels of inflammatory, metabolic, and organ function biomarkers, including NLR, CRP, ferritin, LDH, procalcitonin, glucose, BUN, creatinine, and lactate, in deceased patients, supporting the notion that COVID-19 is characterized by systemic inflammation and multi-organ failure. Logistic regression analysis identified the absence of a COPD/asthma diagnosis, each unit increase in ferritin levels, and the need for invasive mechanical ventilation as independent risk factors for mortality. Conclusion: Advanced age is a significant factor increasing mortality risk in critically ill geriatric COVID-19 patients. The presence of comorbid chronic conditions in elderly individuals further elevates mortality rates. The combined use of CO-RADS, APACHE-II, MuLBSTA, and SII scoring systems significantly enhances the prediction of mortality and clinical course in these patients. In particular, APACHE-II, MuLBSTA, and SII serve as effective tools for the early identification of high-risk patients. The association of CO-RADS stage 6 with high mortality rates underscores the clinical value of advanced radiological findings. Routine implementation of these scoring systems in ED practice could optimize patient management and potentially reduce mortality risk. Keywords: COVID-19, CO-RADS, APACHE-II, MuLBSTA, SII, mortality, emergency department